What is the recommended diet for patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD)?

Recommended Diet for ADPKD Patients

For patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD), a low-sodium, moderate-protein diet with adequate hydration based on thirst is recommended to slow disease progression and reduce complications. 1

Core Dietary Recommendations

Sodium Intake

• Limit sodium to <2000 mg/day 1, 2
• High salt intake is associated with:
  • Higher blood pressure
  • Increased proteinuria
  • Faster progression to end-stage renal disease 1
  • Blunted effectiveness of antihypertensive medications 1

Protein Intake

• Moderate protein intake of 0.6-0.8 g/kg body weight/day for patients with CKD stages 3-5 1
• Increase to 1.0-1.2 g/kg body weight/day if on dialysis 1
• Unnecessary protein restriction should be avoided, especially in children, to prevent malnutrition 1

Fluid Intake

• Drink according to thirst - avoid dehydration 1, 2
• Target >2.5 L daily of fluid intake 2
• ADPKD patients are more sensitive to water deprivation than those with other kidney diseases 1
• While high water intake is often recommended to suppress vasopressin production, evidence from interventional studies does not confirm a clear benefit 1

Weight Management

• Maintain normal body weight - obesity is an independent predictor of faster renal function loss in ADPKD 1
• Consider the weight of cystic kidneys when calculating BMI 1

Additional Dietary Considerations

Caffeine and Alcohol

• Avoid excessive caffeine intake 1
• Limit alcohol to ≤1 drink/day for females and ≤2 drinks/day for males 1

Overall Diet Pattern

• Follow general recommendations for a healthy diet consistent with World Health Organization and CKD guidelines 1
• A Mediterranean diet may be beneficial for improving lipid profiles in CKD patients 1
• Increased fruit and vegetable intake may help decrease body weight, blood pressure, and net acid production 1, 3

Special Considerations

Low-Osmolar Diet Approach

• A low-osmolar diet (low sodium, moderate protein, adjusted water intake) decreased levels of copeptin (vasopressin marker) in adults with ADPKD 1
• Target urinary osmolality <280 mOsM/kg 1
• However, long-term benefits on cyst growth remain speculative 1

Emerging Dietary Interventions

• Caloric restriction, intermittent fasting, and ketogenic diets show promise in preclinical models 4, 5
• These interventions may influence nutrient signaling and substrate availability in cystic kidneys 4
• However, clinical evidence supporting their effectiveness in humans is still limited 5

Practical Implementation

• Work with registered dietitians for individualized counseling, particularly for:
  • Patients with advanced CKD (stages G4-G5)
  • Those at high risk for urinary stones
  • Overweight or obese patients
  • Those with malnutrition or sarcopenia 1

Common Pitfalls to Avoid

• Excessive salt restriction in ADPKD-UMOD and ADPKD-REN patients may aggravate hyperuricemia and volume depletion 1
• Unnecessary protein restriction can lead to malnutrition, especially in children 1
• Vasopressin analogues should be avoided in ADPKD patients, as they can be detrimental to disease progression 1
• Dehydration should be strictly avoided as ADPKD patients are more sensitive to water deprivation 1

A pilot intervention study demonstrated that a composite diet with decreased sodium, protein, acid precursors, and increased fluid intake was feasible and well-accepted by adult ADPKD patients 3, suggesting that these dietary modifications can be successfully implemented in clinical practice.